Severova bolest komplicirana osteomijelitisom

Sever’s disease is juvenile osteochondrosis of calcaneus, manifested with posterior heel pain and mild swelling, usually in young athletes, caused by repetitive microtrauma. The standard diagnostic procedures include radiographs and ultrasound examination. It is a self-limiting condition, usually treated conservatively. We present a case of Sever’s disease complicated with calcaneal osteomyelitis. A 9-year-old boy with a several month history of left heel pain was admitted to our institution for further clinical evaluation and therapy. Bilateral Sever’s disease was clinically diagnosed, confirmed by radiographs and ultrasound examination. Magnetic resonance imaging (MRI) showed osteolytic zone in the posterior left calcaneus with peripheral enhancement after contrast administration and surrounding bone and subcutaneous edema, suggestive of osteomyelitis. After six weeks of parenteral antibiotic treatment, the patient’s condition improved. Follow up MRI performed 3 months later showed significant regression of osteolytic lesion and replacement with granulation tissue surrounded with new bone formation. To our knowledge and literature search, this is a previously unreported complication of Sever’s disease. MRI should be done in all atypical cases of Sever’s disease to rule out any other possible disorders including osteomyelitis.Severova bolest je juvenilna osteohondroza petne kosti koja se manifestira bolovima i oteklinom u stražnjem dijelu pete, najčešće u mladih sportaša, uzrokovana opetovanim mikrotraumama. Slikovna dijagnostička obrada uključuje rendgenske snimke i ultrazvučni pregled. Bolest se liječi konzervativno, budući da prolazi sama od sebe. Prikazali smo devetogodišnjaka sa Severovom bolesti kod kojega standardna terapija nije polučila klinički učinak. Učinjen je pregled pete magnetskom rezonancijom (MR) koji je pokazao Severovu bolest i osteomijelitis petne kosti. MR pregled pete bi trebalo učiniti u svim atipičnim slučajevima Severove bolesti kako bi se isključila druga patološka stanja uključujući osteomijelitis

Severova bolest komplicirana osteomijelitisom

Sever’s disease is juvenile osteochondrosis of calcaneus, manifested with posterior heel pain and mild swelling, usually in young athletes, caused by repetitive microtrauma. The standard diagnostic procedures include radiographs and ultrasound examination. It is a self-limiting condition, usually treated conservatively. We present a case of Sever’s disease complicated with calcaneal osteomyelitis. A 9-year-old boy with a several month history of left heel pain was admitted to our institution for further clinical evaluation and therapy. Bilateral Sever’s disease was clinically diagnosed, confirmed by radiographs and ultrasound examination. Magnetic resonance imaging (MRI) showed osteolytic zone in the posterior left calcaneus with peripheral enhancement after contrast administration and surrounding bone and subcutaneous edema, suggestive of osteomyelitis. After six weeks of parenteral antibiotic treatment, the patient’s condition improved. Follow up MRI performed 3 months later showed significant regression of osteolytic lesion and replacement with granulation tissue surrounded with new bone formation. To our knowledge and literature search, this is a previously unreported complication of Sever’s disease. MRI should be done in all atypical cases of Sever’s disease to rule out any other possible disorders including osteomyelitis.Severova bolest je juvenilna osteohondroza petne kosti koja se manifestira bolovima i oteklinom u stražnjem dijelu pete, najčešće u mladih sportaša, uzrokovana opetovanim mikrotraumama. Slikovna dijagnostička obrada uključuje rendgenske snimke i ultrazvučni pregled. Bolest se liječi konzervativno, budući da prolazi sama od sebe. Prikazali smo devetogodišnjaka sa Severovom bolesti kod kojega standardna terapija nije polučila klinički učinak. Učinjen je pregled pete magnetskom rezonancijom (MR) koji je pokazao Severovu bolest i osteomijelitis petne kosti. MR pregled pete bi trebalo učiniti u svim atipičnim slučajevima Severove bolesti kako bi se isključila druga patološka stanja uključujući osteomijelitis

Endoskopsko liječenje pseudociste gušterače

Pancreatic pseudocyst, the most common cystic lesion of the pancreas, may occur as a consequence of acute or chronic pancreatitis, pancreatic trauma, or obstruction of the pancreatic duct. Symptomatic, complicated, or enlarging pseudocysts require therapy that can be endoscopic (transmural and transpapillary drainage), percutaneous, or surgical. We present a patient with pancreatic pseudocyst treated by blinded endoscopic transgastric puncture and stenting after an unsuccessful attempt at endoscopic transpapillary drainage, suggesting that this simple approach is safe and effective in a selected group of patients.Pseudocista gušterače kao najčešće cistično oštećenje gušterače može nastati kao posljedica akutnog ili kroničnog pankreatitisa, traume gušterače ili opstrukcije gušteračnog kanala. Simptomatične, komplicirane ili pseudociste koje se povećavaju zahtijevaju liječenje koje može biti endoskopsko (transmuralna i transpapilarna drenaža), perkutano ili kirurško. Prikazuje se bolesnica s pseudocistom gušterače liječenom endoskopskom transgastričnom punkcijom naslijepo i postavljanjem stenta nakon neuspjelog pokušaja endoskopske transpapilarne drenaže. Ukazuje se na to da je ovaj jednostavan pristup siguran i učinkovit u odabranoj skupini bolesnika

Vertebralni osteomijelitis u odraslih bolesnika – karakteristike i ishod

The aim of the study was to assess disease characteristics and outcome in patients with vertebral osteomyelitis (VO). A two medical centre retrospective cohort study was performed by chart review after discharge of 110 patients with confirmed VO treated during a 5-year period. Patients were divided in two groups: patients with uncomplicated VO and patients with complicated VO. All patients underwent clinical and biological examinations and magnetic resonance imaging (MRI) according to the same protocol. Patients with complicated VO were significantly older (p=0.038). They were longer treated with antibiotics parenterally (p=0.047) and more often surgically (p<0.001). In these patients, high Charlson comorbidity index (CCI) score was more often observed (p=0.024), as well as liver cirrhosis (p=0.013) and degenerative spine disease (p=0.007) as comorbidities. Patients with advanced MRI changes of VO had a modified CCI score of 2 or more (p=0.006). They more often experienced neurological deficit (p=0.021). Staphylococcus aureus was the most frequently isolated bacterium from blood and tissue samples. Advanced MRI changes and complicated VO were more often observed in patients with high CCI score due to impaired immune system caused by chronic comorbid disease(s) or modulation of immunity with medications. High CCI scores were more frequently associated with positive blood cultures due to bacteremia because of impaired immunity. Patients with complicated VO were longer treated with antibiotics parenterally and more often surgically treated for phlegmon and abscess formation. Liver cirrhosis and degenerative spine disease, which were more often found in patients with complicated VO, obviously impacted the course of the disease.Ciljevi istraživanja su bili prikazati karakteristike i ishod vertebralnog osteomijelitisa (VO) u odraslih bolesnika. Radi se o retrospektivnoj studiji u koju je bilo uključeno 110 bolesnika s VO koji su hospitalizirani u petogodišnjem razdoblju. Bolesnici su podijeljeni u skupinu s nekompliciranim i skupinu s kompliciranim VO. Svi bolesnici su imali nalaze laboratorijskih pretraga i MR pregled kralježnice. Bolesnici s kompliciranim VO su bili značajno stariji (p=0,038), duže su parenteralno liječeni antibioticima (p=0,047) i češće su kirurški liječeni (p<0,001). U istih bolesnika su češće bili zastupljeni viši stupanj komorbiditeta po Charlsonu (engl. Charlson comorbidity index score, CCI score) (p=0,024), ciroza jetre (p=0,013) i degenerativna bolest kralježnice (p=0,007) za razliku od bolesnika s nekompliciranim VO. Bolesnici s uznapredovalim MR promjenama su češće imali viši zbir CCI, 2 ili više (p=0,006) te učestalije neurološke ispade (p=0,021). Staphylococcus aureus je najčešće izolirana bakterija iz krvi i tkiva. Uznapredovale MR promjene i komplicirani VO su češće bili zastupljeni u bolesnika koji su imali viši zbir CCI, najvjerojatnije zbog oštećenja imunog sustava uslijed komorbiditeta ili promjene imunog odgovora lijekovima. Viši zbir CCI je češće bio udružen s pozitivnim hemokulturama uslijed bakterijemije zbog oštećenja imuniteta. Bolesnici s kompliciranim VO su duže parenteralno liječeni antibioticima zbog učestalijih flegmona ili apscesa. Ciroza jetre i degenerativna bolest kralježnice koji su kao komorbiditeti bili učestaliji u bolesnika s kompliciranim VO najvjerojatnije su utjecali na tijek bolesti

Diagnostic imaging in assessment of rheumatic diseases

Reumatske bolesti predstavljaju jedan od najčešćih zdravstvenih problema zbog kojeg bolesnici posjećuju liječnika. Ta činjenica nameće potrebu za objektiviziranjem kliničkih simptoma i jasnim prikazivanjem patomorfoloških promjena prvenstveno zbog izbora najučinkovitijeg načina liječenja. Čitav niz dijagnostičkih radioloških metoda oslikavanja stoji nam danas na raspolaganju: konvencionalna radiografija, konvencionalna mijelografija, kompjutorizirana tomografija (CT), mijelografija kompjutoriziranom tomografijom (CT), magnetska rezonancija (MR), artrografija MR-om ili CT-om, spinalna angiografija, ultrasonografija, te scintigrafija, odnosno udružene radiološke metode i scintigrafske metode (PET-CT). Svaka od navedenih metoda ima svoju važnost, odnosno ima svoje prednosti i ograničenja. Ponekad jedna metoda isključuje drugu, a često se i nadopunjuju u postavljanju konačne dijagnoze. Za pravilan odabir radiološke metode oslikavanja koja će nam dati najpotpuniji uvid u problematiku, potrebno je dobro poznavanje njihovih mogućnosti, jasan klinički upit i prvenstveno, dobra suradnja kliničara i radiologa koji bi trebali biti nosioci dijagnostičkog tima koji postavlja indikaciju za radiološku pretragu.Rheumatic diseases represent one of the most common health problems for which patients visit the doctor. This fact imposes the need for verification of clinical symptoms and clear presentation of pathomorphyology changes primarily because of the best methods of treatment selection. A wide range of diagnostic imaging modalities are available today: conventional radiography, conventional myelography, computed tomography (CT), CT myelography, magnetic resonance imaging (MRI), MR or CT artrography, spinal cord angiography, ultrasound and scintigraphy, and combined radiological methods and scintigraphy (PET-CT). Each of the above methods has its own importance, advantages and limitations. Sometimes a method excludes the other, and often support each another in setting the final diagnosis. For the proper choice of radiological imaging methods that will give us insight into the problem, a good knowledge of their capabilities, and a clear clinical inquiry are necessary. But most of all, good cooperation of clinicians and radiologists who should be diagnostic team responsible for that sets the indication for radiological examination is essential

Korelacija između slikovnog prikaza magnetskom rezonancijom i histopatologije u diferencijaciji bolesti gušterače

In the last four decades, the incidence of pancreatic cancer has tripled in Western countries. More than 90% of all pancreatic cancers are detected in the advanced stage of the disease when surgical treatment is no longer possible and survival after initial diagnosis is usually very short. The aim of this study was to correlate magnetic resonance imaging (MRI) established diagnosis of chronic pancreatitis, benign lesion and malignant neoplasm with final histopathology. The study included 29 patients in whom the nature of pancreatic pathology could not be determined clinically and by other imaging modalities including abdominal ultrasonography, endoscopic retrograde cholangiopancreatography and multislice computed tomography. MRI examination was performed and radiological report was compared with histopathology assessment of the pancreatic lesion detected. The data obtained indicated systematic conformity between radiological and histopathology findings, confirmed high diagnostic accuracy of MRI for selected pancreatic pathology, and demonstrated the role of MRI as a problem solving diagnostic imaging modality in undetermined pancreatic changes.U posljednja četiri desetljeća incidencija karcinoma gušterače se u zapadnim zemljama utrostručila. Više od 90% svih karcinoma gušterače otkriva se u uznapredovalom stadiju kada kirurško liječenje više nije moguće, a preživljavanje bolesnika nakon postavljene dijagnoze je najčešće vrlo kratko. Cilj istraživanja bio je usporediti nalaz magnetske rezonancije s histopatološkim nalazom promjena u gušterači u bolesnika oboljelih od kroničnog pankreatitisa te dobroćudnih i zloćudnih novotvorina gušterače. U istraživanje je uključeno 29 bolesnika kod kojih se narav patološke promjene gušterače nije mogla utvrditi klinički niti drugim radiološkim metodama koje su uključivale ultrazvučni pregled, endoskopsku retrogradnu kolangiopankreatografiju te višeslojnu kompjutoriziranu tomografiju. Podaci istraživanja upućuju na podudaranje u radiološkoj i histopatološkoj prosudbi opaženih promjena, potvrđuju visoku točnost magnetske rezonancije u dijagnostici patoloških promjena gušterače i ilustriraju njenu važnost u procjeni naravi nejasnih promjena gušterače

Radiological manifestations of musculo-skeletal complications in HIV-infected patients

Bolesnici s infekcijom virusom humane imunodeficijencije (HIV) podložni su različitim komplikacijama koje mogu zahvatiti mišićno-koštani sustav. Infekcija (celulitis, nekrotizirajući fascitis, piomiozitis, osteomijelitis, septički artritis) predstavljaju najčešćee komplikacije. Upalna stanja mogu biti uzrokovana samom HIV-infekcijom, ali i potaknuta prilagodbom imunološkog sustava. Mišićni simptomi mogu nastati zbog rabdomiolize, miozitisa ili nuspojava antiretrovirusnog liječenja (ARL). Non-Hodgkinov limfom i Kaposiev sarkom su dvije najčešće neoplazme u ovoj populaciji bolesnika. Starenjem osoba zaraženih HIV-om zapaža se osteopenija, osteoporoza i patološki prijelomi, češće nego u HIV-negativnih osoba. Posebno važan je sindrom osteonekroze koja se rijetko pojavljuje i čiji uzrok nije posve spoznat. Radiologija ima značajnu ulogu u ranoj dijagnostici i planiranju terapijskog postupka. Važno je da radiolog bude upoznat s različitim oblicima mišićno-koštanih oboljenja u bolesnika s HIV-infekcijom tako da može postaviti odgovarajuću diferencijalnu dijagnozu.Patients with human immunodeficiency virus (HIV) infection are susceptible to a variety of complications that can affect musculosceletal system. Infection (cellulitis, necrotizing fasciitis, pyomyositis, osteomyelitis, septic arthritis) is the most common complication. Inflammatory conditions are either caused by the HIV infection itself or triggered by adaptive changes in the immune system. Muscular symptoms may result from rhabdomyolysis, myositis or from sideeffects of highly active anti-retroviral therapy (HAART). Non-Hodgkin lymphoma and Kaposi sarcoma are two most common neoplasms in this patient population. During the aging proces of HIV-infected patients osteopenia, osteoporosis and patologic fractures are observed, more frequently than in non-HIV infected patients. Radiology plays an important role in the early diagnosis and treatment planning. Especially important is the syndrom of osteonecrosis that is not very frequent and whose cause is not well known yet. It is important for the radiologist to be familiar with the different types of musculoskeletal diseases in HIV-infected patients so that an appropriate differential diagnosis can be established